Ahluwalia Nikhil, Raju Hariharan
St George's, University of London, London, UK.
MQ Health Cardiology, Macquarie University, 2 Technology Place, Sydney, NSW, 2109, Australia.
Curr Treat Options Cardiovasc Med. 2018 Aug 27;20(10):82. doi: 10.1007/s11936-018-0678-z.
Pre-participation athlete screening has led to the referral of asymptomatic athletes with a prolonged QT interval warranting their evaluation for long QT syndrome (LQTS). Establishing a diagnosis of LQTS can be difficult, particularly in asymptomatic athletes presenting with a prolonged QTc < 500 ms. This review examines the evaluatory pathway to ascertain the common pitfalls leading to mis- or overdiagnosis. We discuss the advanced ECG-based tools and consider their application in the diagnostic process.
Critical analysis of the ECG, symptom, and pedigree analysis has established value but relies on experienced interpretation. Protocolisation of the former has effectively reduced error. Exercise recovery ECG testing has demonstrated diagnostic value and provocation testing, reliant on QT hysteresis in LQTS, have shown reasonable sensitivity. Although it is becoming more established in experienced centres, its diagnostic value relies on effective risk stratification and subject selection. LQTS is a rare condition and the precision of any available test is greatly diluted if pre-test probability is low. Clinical and familial evaluation and exercise ECG testing are the foundation of the evaluatory process following referral. Adjunctive tests may have high sensitivity for LQTS but rely on high pre-test probability. Several pitfalls have been identified that can lead to misdiagnosis and thus informed evaluation at an experienced specialist centre is appropriate.
运动员参赛前筛查导致了对QT间期延长的无症状运动员进行转诊，以便对其进行长QT综合征（LQTS）评估。LQTS的诊断可能具有挑战性，特别是对于QTc<500ms的无症状运动员。本综述探讨评估途径，以确定导致误诊或过度诊断的常见陷阱。我们讨论了基于心电图的先进工具，并考虑其在诊断过程中的应用。
对心电图、症状和家族史分析的批判性分析具有一定价值，但依赖于经验丰富的解读。前者的标准化有效地减少了误差。运动恢复心电图测试已证明具有诊断价值，而依赖于LQTS中QT滞后现象的激发试验显示出合理的敏感性。尽管在经验丰富的中心其应用越来越广泛，但其诊断价值依赖于有效的风险分层和受试者选择。LQTS是一种罕见疾病，如果预测试概率较低，任何现有检测的准确性都会大大降低。临床和家族评估以及运动心电图测试是转诊后评估过程的基础。辅助检查对LQTS可能具有高敏感性，但依赖于高预测试概率。已经确定了几个可能导致误诊的陷阱，因此在经验丰富的专科中心进行明智的评估是合适的。
